Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration

Abstract

ImportanceStudies have suggested a rise in opioid- and stimulant-involved overdoses in recent years in North America. This risk may be acute for individuals who have had contact with the criminal justice system, who are particularly vulnerable to overdose risk.ObjectiveTo examine the association of opioid and/or stimulant use disorder diagnoses with overdose (fatal and nonfatal) among people with histories of incarceration.Design, Setting, and ParticipantsIn this cohort study, population-based health and corrections data were retrieved from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of residents of British Columbia. The analysis included all people in the 20% random sample who had a history of incarceration between January 1, 2010, and December 31, 2014. Outcomes were derived from 5-years of follow-up data (January 1, 2015, to December 31, 2019). Statistical analysis took place from January 2022 to June 2022.ExposuresSubstance use disorder diagnosis type (ie, opioid use disorder, stimulant use disorder, both, or neither), sociodemographic, health, and incarceration characteristics.Main Outcomes and MeasuresHazard ratios (HRs) are reported from an Andersen-Gill model for recurrent nonfatal overdose events and from a Fine and Gray competing risk model for fatal overdose events.ResultsThe study identified 6816 people (5980 male [87.7%]; 2820 aged <30 years [41.4%]) with histories of incarceration. Of these, 293 (4.3%) had opioid use disorder only, 395 (6.8%) had stimulant use disorder only, and 281 (4.1%) had both diagnoses. During follow-up, 1655 people experienced 4026 overdoses including 3781 (93.9%) nonfatal overdoses, and 245 (6.1%) fatal overdoses. In adjusted analyses, the hazard of both fatal (HR, 2.39; 95% CI, 1.48-3.86) and nonfatal (HR, 2.45; 95% CI, 1.94-3.11) overdose was highest in the group with both opioid and stimulant use disorder diagnoses.Conclusions and RelevanceThis cohort study of people with a history of incarceration found an elevated hazard of fatal and nonfatal overdose among people with both opioid and stimulant use disorder diagnoses. This study suggests an urgent need to address the service needs of individuals who have had contact with the criminal justice system and who co-use opioids and stimulants.

Forecasting drug-overdose mortality by age in the United States at the national and county levels

“…To estimate age-specific influx rates of high-risk drug consumers and age-specific mortality rates, we use the age-structured population data and fatal overdose data tallied by the CDC WONDER database as inputs to our EnKF. Since we consider the entire population of those who use high-risk drugs, overdose deaths may arise among those who suffer from SUD as well as intermittent or first-time users who accidentally overdose on contaminated doses or due to inexperience ( 59 , 60 ). Figure 1 a,b shows the evolution of the US population and overdose fatalities from 1999 (light blue) to 2021 (dark blue).…”

Synthesis of α3β4 Nicotinic Acetylcholine Receptor Modulators Derived from Aristoquinoline That Reduce Reinstatement of Cocaine-Seeking Behavior

“…36,37 Furthermore, the risk of overdose and overdose death is highest at the point of relapse when patients' previous tolerance has diminished, thereby making them more sensitive to a low dose of stimulant. 38 In the past decade, cocaineassociated overdose deaths have nearly tripled. 2 Therefore, the effectiveness of 1 in preventing drug-seeking behavior in a model of cocaine relapse suggests there is great clinical utility as a novel pharmacotherapy for CUD.…”

“…Although drug cessation is an important translational focus for developing CUD treatments, relapse rates of stimulant use disorders, which include CUD and amphetamine use disorder, are among the highest for any SUDs . Almost 75% of patients with a stimulant use disorder will relapse in two to five years. , Furthermore, the risk of overdose and overdose death is highest at the point of relapse when patients’ previous tolerance has diminished, thereby making them more sensitive to a low dose of stimulant . In the past decade, cocaine-associated overdose deaths have nearly tripled .…”

Factors associated with obtaining prescribed safer supply among people accessing harm reduction services: findings from a cross-sectional survey

“…This highlights the need for increased resources for people who engage in polysubstance use and more efforts to determine how concurrent use of stimulants and opioids can be addressed through a combination of PSS and adjacent harm reduction and substance use treatment services that meet client goals. Harm reduction services and broader health system contact is particularly important for this population, given studies have identi ed elevated risk of a number chronic disease diagnoses for people with concurrent opioid and stimulant use disorders (37), and co-use of opioids and stimulants has been associated with increased risk of infectious disease (38).…”